POS1181 INFECTIOUS COMPLICATIONS OF BIOLOGIC THERAPY IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISM
Authors: F. Idrissi Zaki, F. E. Chekkouri, A. Mougui, I. El Bouchti
Journal: Annals of the Rheumatic Diseases (2022)

Background The appearance of biological disease-modifying drugs (bDMARDs) has revolutionized the treatment of rheumatic diseases. However, their functions in modulating pro-inflammatory cytokines and acquired immunity largely increase the risk of infections. Objectives The aim of this work is to study the epidemiological, clinical and biological characteristics of infections occurring under biotherapies, and to identify the factors associated with its occurrence. Methods It is a retrospective descriptive study including patients with chronic inflammatory rheumatism between 2006 and 2021 and who were placed during their follow-up under a biotherapy. Statistical data analysis was performed using SPSS version 20 software. The bivariate study was performed by Chi-square test. Results Of the 106 cases reported, 68 infectious episodes were counted in 46 patients (43.4%) who had at least one infection with biotherapy: 56.5% women and 43.5% men with an average age of 50.9 ± 14.29 years. These included rheumatoid arthritis in 16 patients (34.8%), spondylarthritis in 29 patients (63%) and one case of psoriatic arthritis. All patients were on conventional treatments before switching to biotherapy. The infections occurred under Rituximab in 43.8% of the cases, under Infliximab in 33.3% of the cases, under Etanercept in 25% of the cases (a total of 60.9% of the cases were under anti-Tumor Necrosis Factor) and tocilizumab in 12.5% of cases. The infection was of bacterial origin in 40.7% of cases: 27.3% urinary tract infections, 20.5% bronchial infections, 11.4% skin infections, 6.8% septic arthritis. Fungal infections were found in 33.3% of cases in relation to dermatophyte infections and intertrigo. A viral origin was noted in 25.9% of the cases: 5 cases of labial herpes and only one case on herpes zoster. C-reactive protein was increased in 47.2% of cases with a mean value of 36 ± 29.6 mg /L, the hemogram showed hyperleukocytosis in 50% of cases with neutrophil predominance. The treatment was medical in the majority of cases (94.9%), it was both medical and surgical in one case. The favorable outcome in all patients was marked by a temporary interruption of 3.27 ± 1.84 weeks of biotherapy. In multivariate analysis, an association was found between bacterial infection and both female gender (p=0.033), low socioeconomic level (p=0.033), Methotrexate + bDMARDs intake (p=0.027), corticosteroids + bDMARs intake (p=0.014) and Between fungal infection and bDMARs +corticosteroids intake (p=0.044). Conclusion The risk of infection is higher in patients with chronic inflammatory rheumatism, especially if they are under biotherapy. It turns out that bacterial and fungal infections are the most common in this study. Patients taking Rituximab or Infliximab are the most affected by these infectious episodes. References [1]Meyer-Olson D, Hoeper K, Schmidt R. Infektionskomplikationen unter Biologika-Therapie bei Patienten mit rheumatoider Arthritis. Z Rheumatol. 2010 Dec;69(10):879-88. [2]Lortholary O, Fernandez-Ruiz M, Baddley JW, et al. Infectious complications of rheumatoid arthritis and psoriatic arthritis during targeted and biological therapies: a viewpoint in 2020. Annals of the Rheumatic Diseases. 2020;79:1532-1543. [3]Davis JS, Ferreira D, Paige E, Gedye C, Boyle M. Infectious Complications of Biological and Small Molecule Targeted Immunomodulatory Therapies. Clin Microbiol Rev. 2020 Jun 17;33(3). Disclosure of Interests None declared